Professional Documents
Culture Documents
WORKING
IMPRESSION
Congestive
Heart Failure 2O
Congenital Heart
Disease probably
Atrial Septal
defect with
concomitant
pneumonia and
moderate
dehydration
RULE IN
RULE OUT
(-)fever, chills
Acute Bronchitis
Cystic Fibrosis
Dyspnea
Orthopnea(difficulty breathing in supine)
Diaphoresis
PE:
cardiorespiratory distress
tachypnea, tachycardia
Nasal flaring
clear nasal discharge
Intercostal, suprasternal & subcostal retractions
Crackles & wheezes are heard over both lung fields
with occasional grunting
Hx: Hacking cough
watery nasal discharge
Irritability, poor feeding
Dyspnea
Orthopnea(difficulty breathing in supine)
Diaphoresis
PE: cardiorespiratory distress
tachypnea, tachycardia
Nasal flaring
clear nasal discharge
Intercostal, suprasternal & subcostal retractions
Crackles & wheezes are heard over both lung fields
with occasional grunting
Hx: prolonged pulmonary infection
Hacking cough, watery nasal discharge
Irritability, poor feeding
Dyspnea
Diaphoresis
PE:
cardiorespiratory distress
tachypnea, tachycardia
Nasal flaring
clear nasal discharge
Intercostal, suprasternal & subcostal retractions
Crackles & wheezes are heard over both lung fields
with occasional grunting
Signs of dehydration: irritability, slightly depressed
fontanel , dark yellow urine
ROS: poor weight gain, dyspnea
(-) fever
(-) environmental
exposure
(-)localized
lymphadenopathy
In severe exacerbations of asthma, the greater extent of airways obstruction causes labored breathing &
respiratory distress, which manifest as inspiratory wheezing, suprasternal & intercostal retractions, nasal
flaring. These manifestations are present in our patient.